Treatment of inflammatory bowel disease . Goals of treatment. Goals of Treatment. Asacol ®. AZO-COMPOUNDS. Stomach. Small Intestine. Large Intestine. Mesalamine w/ eudragit-S. Azo bond. Oral 5-ASA Release Sites. Pentasa ® . Mesalamine in microgranules. Aminosalicylate.
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Treatment of inflammatory bowel disease
Mesalamine in microgranules
The aim should be to withdraw corticosteroids completely.
E F Stange, S P L Travis; ECCO Consensus on the diag&Mang of CD”Gut 2006;55(Suppl I.)
Ulcerative Colitis: Mild to Moderate
Patient willing totake rectal therapy
Patient unwilling to take rectal therapy
Consider rectal therapy(5-ASA and/or steroid)
Ulcerative Colitis: Moderate to Severe
Maintain on5-ASA and observe
Therapeutic Pyramid for
Analysis of 917 UC patients at Heidelberg University between 1982 and 2001
Colorectal ca 7%
Hoffmann et al. Chronisch-Entzündliche Darmerkrankungen. Thieme 2004
1Sagar PM, Pemberton JH. In Satsangi J, Sutherland L, et al, eds. Inflammatory Bowel Diseases. Spain: Elsevier Limited; 2003:491 511.
2Pemberton JH, et al. Ann. Surg. 1987;206(4):504-513. 3Olsen, KO, et al. Gastroenterology. 2002;122:15-19.
4Johnson P, et al. Dis Colon Rectum. 2004;47;1119–1126. 5Gorgun E, et al. Surgery. 2004;136(4):795–803.
6Stange et al. Colitis ulcerosa – Morbus Crohn.Uni-Med Verlag AG 1999.
Treatment of crohn’s disease
Sequential escalation based upon symptoms, usually starting with the
efficacysafest medication but with the least
Most prevalent strategy
Advantages: minimize risks of adverse drugs effects
Disadvantages: risk of inadequate treatment, not targeting
the underlying process, i.e. the inflammation and the
Therapy with a potent agent since the beginning
Advantages: strong suppression of inflammation
Disadvantages: Expensive, treats all patients as if
they have identical risk and lead to unnecessary
exposure to adverse drug effects
Cancer in IBD
Choi PM, et al. Gastroenterol Clin North Am 1995;24:671-87.
Eaden J. Am J Gastroenterol 2000;95:2710-2719.
Ekbom, et al NEJM, 1990